Pride Month, which fell on June, was a time for celebration, reflection, and remembrance of LGBTQ+ struggles and achievements. Throughout the United States’ history, the LGBTQ+ community has faced various health challenges and inequities, from the HIV/AIDS epidemic in the 1980s to the mpox outbreak last year.
Although LGBTQ+ individuals’ access to health care has improved compared to decades prior, various health concerns and disparities remain pertinent, says Erick Eiting, MD, MPH, Medical Director for the Emergency Department at Mount Sinai Beth Israel and for the Urgent Care Center at Mount Sinai-Union Square.
During Pride Month, Dr. Eiting and Antonio Urbina, MD, Medical Director of the Institute of Advanced Medicine, discussed health topics LGBTQ+ individuals should keep in mind, even as they celebrate the progress that has been made.
STI Testing: What’s Important?
Who should be thinking about getting tested for sexually transmitted infections (STIs)? Anyone who is sexually active should be considered for sexual health screening, although some groups may be more at risk, says Dr. Urbina.
While there is no hard rule for how often one should get tested, health providers at Mount Sinai offer screening every three months. These should include not only testing at genital sites, but also others including the throat and anal/rectal regions.
“That’s especially important because oftentimes, someone can have an STI in those compartments and they don’t have any symptoms at all,” says Dr. Urbina, “so the only way that you’re going to be able to detect them is if you actually swab or screen those areas as well.”
Common tests for gonorrhea, chlamydia, and syphilis help detect infection and initiate treatment if needed. But other important tests include those for HIV, meningococcal meningitis, and human papillomavirus for vaccination and preventive purposes, Dr. Urbina adds.
HIV: Counseling, Testing, Treatment, Management
As it is hard to know, through initial conversations, which patients might be at risk for HIV, it is incredibly important for health providers to make sure they are not using judgmental language or biases during their interactions, says Dr. Eiting.
“It’s really important for everybody to know their status,” notes Dr. Eiting.
Telling someone that they are HIV-positive when they don’t already know is probably one of the most difficult conversations to have, he adds.
It is really important for people to know that having HIV is considered by the medical community these days as a chronic disease that is oftentimes well-managed with medication, Dr. Eiting says. It is also important for them to have a support system in place so that they may transition into living their lives with the condition, since HIV isn’t the same kind of disease that it was decades ago.
It is important for people who test negative for HIV to consider the possibility of being on pre-exposure prophylaxis, or PrEP. In addition to a daily pill that can be taken, there is now a long-acting injectable PrEP that is given every two months by intramuscular injection into the buttocks.
“I think it’s all about empowering patients to taking steps that best fit their lifestyles for prevention,” says Dr. Urbina.
As a result of advancements in modern medicine, there are now people with HIV living into their 90s, and more attention needs to be placed on this elderly group. They tend to exhibit a little more physical vulnerability and frailty due to having lived with the virus for so long, says Dr. Urbina. More aggressive screening for malignancies or bone density loss are recommended too.
Mental Health and Substance-Use Disorders
LGBTQ+ people have been observed to have higher rates of psychosocial issues, including depression and substance-use disorder, and health institutions need to reach out to serve these communities better, says Dr. Urbina.
What is PrEP?
Pre-exposure prophylaxis, or PrEP, is a pill or injection that lowers the risk of getting HIV from sex by about 99 percent, according to the Centers for Disease Control and Prevention. Using PrEP, however, does not prevent other sexually transmitted infections (STIs).
“I think it’s important for us to sometimes take pause and take stock and remember that even though Pride Month is a month of celebration, and to acknowledge how far we’ve come, we have to remind ourselves that it can often be a time when it really enhances isolation for patients who are feeling that as well,” says Dr. Eiting.
Seeking help for mental health or addiction can be daunting for patients due to stigma. But health providers at clinics across the city, including at Mount Sinai, are being trained to make access comfortable and judgment-free, and so patients should not hesitate to tap those resources when needed, Dr. Eiting says.
Affirming Across the Entire Spectrum
Even though the L in LGBTQ+ comes first, the lesbian community can sometimes be forgotten with respect to health care, notes Dr. Eiting. It is important for health providers to be aware of things like breast cancer or cervical cancer screening for this population.
Studies suggest that some lesbian and bisexual women get less routine health screenings than their heterosexual counterparts due to various factors, including fear of discrimination or low rates of health insurance.
Transgender health care encompasses not just gender-affirming surgeries, but also primary care. For transgender patients, sometimes seeking health care can be stressful because if the conversations are not conducted in a respectful way, they can cause dysphoria.
But stigma should not get in the way of having people live their fullest lives, and transgender individuals should take stock of what their health needs are and have conversations with their doctors, says Dr. Urbina.
Given the current climate of anti-transgender sentiment and legislation across the country, health providers should acknowledge that these developments do leave an impact on their transgender patients. “It’s just important for us to acknowledge that that’s out there… and to make sure that we’re using principles of trauma-informed care whenever we’re talking to our patients about their health care,” says Dr. Eiting.
Read more about how Mount Sinai is empowering health care for LGBTQ+ communities